=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598910002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUFFALO CENTER VOLUNTEER AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 11/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 1ST AVENUE NW
-----------------------------------------------------
City | BUFFALO CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50424-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-562-2505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 437
-----------------------------------------------------
City | BUFFALO CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50424-0437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-562-2505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SEC. / TREASURER
-----------------------------------------------------
Name | MARSHA PETERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 641-562-2505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 2950100
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------